Indra C Shah

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

023224 Issued in GA

Practice address

601 Old Norcross Rd Ste a
Lawrenceville, GA 30046-4311

Phone

(770) 963-2474

Fax

(770) 963-2476

NPI assigned

Mar 13, 2007

Last updated

Feb 16, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Indravadan C Shah Other name

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northside Primary Care Professional Services,LLC

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1922397553
  Medicare reassignment NPD
• Douglas County Family Practice, P.C.

  • Family Medicine Physician
  • Douglasville, GA
  • NPI 1083769376

  Internal Medicine

  NPD
• Northside Primary Care Professional Services, LLC

  • Urgent Care Clinic/Center
  • Dawsonville, GA
  • NPI 1215369715
  NPD
• Douglas County Family Practice, P.C.

  dba Mariam George, M.D.

  • Primary Care Clinic/Center
  • Douglasville, GA
  • NPI 1013918671
  NPD (past)
• Tri County Medical

  • Physical Disabilities Residential Treatment Facility
  • Roswell, GA
  • NPI 1285680587
  NPD (past)
• Vpa PC

  dba HarmonyCares Medical Group

  • Family Medicine Physician
  • Brentwood, TN
  • NPI 1578363362

  Internal Medicine

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297814400000",
    "number": "1639202120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 OLD NORCROSS RD STE A",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300464311",
            "telephone_number": "770-963-2474",
            "fax_number": "770-963-2476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 OLD NORCROSS RD STE A",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300464311",
            "telephone_number": "770-963-2474",
            "fax_number": "770-963-2476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "INDRA",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-13",
        "last_updated": "2011-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "023224",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD LICENSE",
            "identifier": "23224",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "INDRAVADAN",
            "last_name": "SHAH",
            "middle_name": "C",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Ruth-Ann Samantha Shackleford
• Camille Elyse Shaffer, LMSW
• Farina Shafqat, MD
• Shah Pediatrics,Inc
• Deep Shah, MD
• Jayendrakumar J Shah, MD
• Karan R Shah, PHARMD
• Kirti K Shah, MD
• Mahendra Ratilal Shah, MD
• Priyal Shah

• Internal Medicine Physician in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.